Teaching Flashcards
lung nodules <5mm have risk of cancer same as
ano other lobe without a nodule
M1a vs b vs c for lung tumours
met to effusion or other lung
extrathoracic site
???
poditive nodes for classyfying in lung CT
> 10mm in short axis
differetial for spiculated mass
tuberculoma
Brock uni score
likelihood of cancer in lesion on CT - proven to be cancer in the next 2-4 years.
chest radiograph - dene ribs
consider haemotologialdiseases - mylefibrosis
ILD - IPODS
irradiation
pets
occuption
drus
smoking
IPODS is useful mnemonic for reporting what
HRCT
important history for ILD
HIV
medication s
VTE
autoimmune conditions
DCC for reporting pattern
Describe - which zone is it in, greater in some areas compared to others
Chronology
context
ILD types - smoking related
RBILD DP
ILD types chronic fibrosing
NSIP UIP
ILD types subacute
COP
ILD types rare
PPFE and lymphoid interstial pneumonia
ILD - fibrosing conditions need to be seperated from what?
hypersensitivity
Hypersensitivity reaction respond well to what common drug
steroid
ILD - cyst findings think -
Langerhand cell histiocytosis, lymphangioleiomyomatosis
ILD - perilymphatic nodules think
sarcoid, chronic berylliosis, lymphangitic carcinomatosis, lymphoma
ILD - centrilobular nodules think
Hypersensitivity pneumonitis
ILD - tree in bu
infection , aspiration, bronchiolitis
cystic vs reticular in ILD
cysts - lymphangiomyomatosi
???
Hypersnesitivity things to look for
Central and peripheral
air trapping
spare angles - at the bottom it is clear
Hypersnsitivity lungs can be classified into two what are they
fibrotic
non fibrotic
NSIP
interstitial pneumonitits - what to look for
Peripheral
lines and Ground Glass
Basal
UIP
- what factors to look for
Honeycombing
peripheral and basal
Rheumatoid - what drug can cause pneumonitits?
Methotrexate
scleroderma features
bronchial dilatation
consoidation moving from place to place
cryptogenic organising pneumonia
ATOL sign
thymus is split is a sign of
angels wings
paediatric films
pneumomediastinum
thymus should be what
bilobed
homogenous
in the right location
which is better cholecystostomy vs hot cholecystectomy
recent CHOCOLATE trial - compared.
Hot lap chole did better
Osteochondromas is what
bone dysplasia
main feature is bone remodelling and exoptosis
fibrous corticol defect can also be called
non ossified fibromas
Osler webber randu
Automsommal dominant create fistulas
why do mets enhance?
break the blood brain barrier
N O D
Neoplasm
Opportunistic infeciton
Drugs
Multiple leukoencehpalitis is caused by
JC virus
Thyroid nodules are graded how?
1 - 5 TYRADS score from US
Do you biospy thyroid nodules?
Some - avoided due to vascular supply - better to do FNA
If find nodule is hot on FDG or PET CT recommend
US FNA
FDG avid percentage chance of being malignant?
Can be up to 40%
Why do NM thyroid examintions?
Hyperthyroidism
Thyrotoxicosis
Iodine 131 used for
treatment
Iodine 123
diagnostics
Technetium half life
6hrs
photons from technetium
140keV
Iodine 123 kV
190keV
Iodine 131 half life
8 days
Iodine 131 energy
high energy and beta decay (few mm)r
pertechnetate - is treated like what ion in the body
Chloride ions
What is the key difference between iodine and pertechnetate in the thyroid
Thyroid will incorporate the radioiodine into the hormone and so hangs around longer
Normal thyroid on NM scans is symmetrical or asymmetrical?
asymmetrical is normal
Patient asked to swallow during image taken on NM - why?
saliva contains the radioracer
What other tissue will take up the tracer aside from salivary glands for pertecnotate (clrodieions0
Gastric mucosa
some soft tissue
lactating breasts
what drugs contain idoine?
Amioderone
some cough medicine
contrast
Marker on thyroid uptake scans
ankle of louis for retrosternal growth
how to review the intensity of thyroid uptake?
compare to adjacent structures - salivary glands
when reviewing the thyroid scans what do you look for
intensity
whether it is homogenous it
Pyramidal lobe is visible on thyroid uptake scans
pathopnemonic for Graves disease
how do you block thyroid in Graves?
Carbimazole
Does carbimaozole affect the scan?
thyroid scanning
Doesn’t affect if using it pertecnotate
Iodine 123 - it would as the carbimazole will reduce the uptake of iodine into the thyroid
if hyperthyroid with reduced thyroid uptake - what is group of thyroid conditions
Thyroiditis like de Quervains
strumae ovari can produce what type of tissue rarely
thyroid tissue
de quervains is often how long after a viral infection
a few weeks
Causes of plexopathy after surgery?
can be due to extension of the nerves
OPLL happens where
Th cervical spine
calcifiaction adjacent to the spinal cord
condyle vs coronoid
condyle is bigger
Lamina dura is what
the line outside healthy teeth
Periodontal ligament
adjacent to the tooh
what can happen to the lamina dura in a fracture?
it can also fracture
how to tell a tooth abscess?
look for disappearance of the lamina dura
commonest mandibular cyst
dentigurous cyst - noramally around a non erupted tooth. Can have a bubbly appearance.
Can be an ameloblastoma
hyperexpansion of the mandible?
can be fibrous dysplasia
Eagles syndrome?
ossification of the stylohyoid muscle
what is radio osteo necrosis
can get pathological fractures from this .
CT sinsues - agressive pathology
infection
tumour
non aggressive CT sinsues pathology
plasmacytoma / myeloma
CT sinsues - most pathology is…..
benign
Which plane best for the sinuses?
coronals
Osteomeatal complexes - why is this key in CT sinsues
?????
why are ct sinuses pixelly on imaging?
low dose only required given the excellent contrast between structures.
different to high penetration needed for inner ear due to petrous bone
Halleras air cell?
air cell under the orbit
can cause orbital dihiscence during surgery
uncinate process on the inferior border of osteomeatal complex - what does operating on this do?
widens the exit from the sinus
LMG is now called
variant of Wegeners
expanded sinus with a polyp occuyping the nasal cavity and posterior space - called?
anterocoranal polyp
cinsu poylyp in young men - cherry red on endoscope. ENT are advised not to biospy due to being vascular?
juvenile angiofibroma
juvenile angiofibroma will appear as what on MRI
salt and pepper appearance
what is an cholesteatoma ?
in inner ear - cholestrol cells deposits that invades the ear and surrounding bone.
lots of moving nearby structures, more erosions.
hard to discern from inner infection.
concha bullosa
normal variant
airated middle turbinate
lamina propurechea - what to look for?
erosions.
can be from a frontal muccele
tetth best looked in what plane?
saggital
20% of sinuses disease may be related to what?
Teeth
bronchiectasis - features on radiographs
kind of thickened bronchus, nearly tram lines levels.
cysts
air trapping shows as what on CT
areas without blood vessels, oligaemic
Kartageneres - get what in the sinuses?
thickened mucus / walls
ring sign - considered with what condition of bronchiectasis
cystic fibrosis
massive bullous emphysema caused by
ALpha anti trypsin disease
cannabis smoking (allergic reaction)
cause of bronchiectasis with difficulty swallowing?
aspiration
Traditional types of bronchiectasis
cystic
varicose
cylindrical
old version
practical way of classifying bronchiectasis
primary - idiopathic, primary bronchial disease like ciliary dysmotiity
secondary - aspirations,
or both like TB
worse type of bronchiectasis to get
cystic and varicose
Traction bronchiectasis is seen in….
NSIP
UIP
but not a primary bronchiecctic disease as the interstiital disease is what pulls open the bronchi
Definie bronchiectasis
Artery to bronchus ratio on CXR. 0.9 to 1 in UZ. 1.1 to LZ. But
on CT
more precise
normal range of different in ratio of us to 1.3.
signet ring sign
fishermans ring
fishermans ring is named aftre whome?
Pope.
Tramline sign -
seen on CXR/ thickened and dilated bronchi.
Finger in glove sign
thickened bronchi with ffluid in it
signet ring sign -
the bronchi are much bigger than associated artery. Looks like a flashy diamond ring.
bronchiectasis can arise in immunocompromised patients. Form
asperigillomas
- growth into a cavity that preo-exists
bronchiectasis can arise in immunocompromised patients. Form
asperigillomas
- growth into a cavity that preo-exist
signs of gout
soft tissue swelling
tophi in soft tissue
deformity
does not affect bone density
rib notching caused by
coartation blood diverison through intercostals
radiographs - fallen fragments are what?
bone falls within cysts - diagnosis of humeral cysts
SUV stand for?
standard uptake value in Nuclear medicine
SUV of mediastinum
2.3
SUV of lung
0.9
how can axillary lymph nodes be avid with nuclear uptake but not related to underlying disease?
vaccinations
Nuclear medicine normal variant - supraclavicaular fossa
brown fossa